S3874 Colonic Stricture: A Rare Complication After Selective Therapeutic Embolization for Active Lower Gastrointestinal Bleed

Introduction: The incidence of lower gastrointestinal bleed (LGIB) in the United States is calculated to be around 20 cases per 100,000 individuals. Most cases are secondary to diverticulosis, angiodysplasia and malignancy. In most cases, the bleeding will stop spontaneously, however in about 10%-15% of cases further intervention will be needed, either endoscopic or arterial embolization. Selective arterial embolization is a highly effective and safe treatment, but it is not exempt from rare complications. Here we present a patient who developed a colonic stricture after undergoing embolization. Case Description/Methods: An 86-years-old man with a history of recurrent lower gastrointestinal bleed secondary to colonic angiodysplasia, status post previous successful endoscopic therapy and anticoagulation use, presented with a new episode of severe lower gastrointestinal bleed. A computed tomography angiography of the abdomen and pelvis showed active contrast extravasation in the cecum. He underwent selective arterial embolization of distal branches of the ileocolonic artery. The bleeding was successfully controlled; however, over the following months the patient developed recurrent episodes of abdominal pain, nausea and vomiting consistent with a partial bowel obstruction. After imaging and endoscopic studies were done a colonic stricture was found in the ascending colon, suspected to be secondary to ischemia. The patient underwent a right colectomy with ileocolonic anastomosis and had an uneventful post-surgical clinical course. Discussion: The management of lower gastrointestinal bleed (LGIB) involves supportive management, endoscopic interventions with both diagnostic and therapeutic purposes and in some cases selective arterial embolization is needed. This is a very effective and generally considered safe intervention, with very few complications. Among these complications, the development of a bowel stricture is particularly rare and it is thought to result from ischemia, inflammation and eventual tissue fibrosis. We hope to assist other clinicians during the process of making the appropriate diagnosis and proceeding with the indicated interventions when presented with similar clinical scenarios.